Period pain (dysmenorrhoea) is very common. But when pain is severe enough to miss school or work, needs strong painkillers, or comes with other symptoms, it may signal an underlying condition such as endometriosis. WHO estimates endometriosis affects roughly 10% of reproductive-age women and girls globally, yet diagnosis is often delayed for years because pain is normalised or dismissed. Nurses can help women be heard.
Primary vs secondary dysmenorrhoea
- Primary: cramping pain with periods, without an underlying disease. Usually starts within a few years of the first period and may improve with age or after childbirth.
- Secondary: caused by a condition such as endometriosis, adenomyosis, fibroids, pelvic inflammatory disease or an IUD.
Endometriosis: what to look for
Endometriosis is a condition in which tissue similar to the lining of the womb grows outside it, causing inflammation and scarring. Symptoms include:
- Severe period pain that affects daily life.
- Chronic pelvic pain.
- Pain during or after sex.
- Painful bowel movements or urination during periods.
- Heavy periods, fatigue.
- Difficulty getting pregnant.
Diagnosis may involve history, examination, ultrasound or MRI, and sometimes laparoscopy. A normal scan doesn’t rule it out.
Managing period pain
- NSAIDs (e.g. ibuprofen, mefenamic acid), started at the onset of pain or just before the period, are often first-line, if not contraindicated.
- Paracetamol, alone or combined.
- Heat: hot water bottle or heat pad.
- Exercise and relaxation.
- Hormonal treatments: combined pills, progestogen-only options, hormonal IUD, can reduce pain and bleeding.
- Endometriosis may require specialist hormonal treatments or surgery, and support for fertility.
When to refer
- Pain not controlled by simple measures.
- Pain outside periods, with sex, or with bowel/bladder symptoms.
- Fertility concerns.
- Heavy or irregular bleeding, bleeding between periods or after sex.
- Abnormal findings on examination.
- Acute severe pelvic pain with fever or collapse: consider ectopic pregnancy, ovarian torsion, PID. See ectopic pregnancy.
Listen and believe
Many women with endometriosis describe being told “all women have pain” or “it’s in your head”. A simple question such as “Does your period pain stop you from doing normal activities?” can open the door. Period poverty and lack of sanitary products also affect girls’ schooling in many countries; nurses can advocate for menstrual health in schools and communities.
Nurses with endometriosis
Long shifts and limited breaks can make symptoms harder. Talk to occupational health about adjustments; supportive managers make a difference.
Based on WHO endometriosis fact sheet, NICE NG73 (Endometriosis) and NICE CKS (Dysmenorrhoea). Educational content.